6. Cross-Departmental and Cross-Sectoral issues

6.1 Introduction

In the past, people with disabilities had most of their needs addressed within the ambit of specialist disability services which were generally funded by the health sector. For example, up to 1996 the Disabled Persons Maintenance Allowance was administered by the former Health Boards. The Commission on Disability welcomed the transfer of this scheme (which was renamed Disability Allowance) to the Department of Social Welfare in 1996 as it was "the agency responsible for mainstream income maintenance payments". With public services now legally obliged to serve people with disabilities as part of their core activities (a policy referred to as "mainstreaming"), responsibility for non-core health activities such as housing, income support measures and vocational training and employment should move from health-funded disability services to the corresponding mainstream service.

Section 32 of the Disability Act requires that the sectoral plan of the Minister for Health & Children contain information regarding three areas of cross-departmental and cross-sectoral concern, namely -

  • Arrangements for co-operation by the Health Service Executive with housing authorities in relation to the development and co-ordination of the services provided by housing authorities for persons with disabilities (Section 32.1.d);
  • Arrangements for co-operation by the Minister for Health & Children with the Minister for Social and Family Affairs and the Minister for Enterprise, Trade and Employment in relation to development and co-ordination of services provided by those Ministers for persons with disabilities which are related to the health services (Section 32.2).

In the preparation of this chapter of the Sectoral Plan, officials from the Department of Health & Children, together with officers of the Health Service Executive (HSE) where appropriate, met separately with officials from the three other Departments concerned, namely -

  • The Department of the Environment & Local Government, in relation to housing issues;
  • The Department of Social and Family Affairs, in relation to income support measures; and
  • The Department of Enterprise, Trade & Employment, in relation to vocational training and employment issues -

to discuss the issues involved and to agree on joint approaches. In each case, the issues of concern have been identified and clarified and a strategy to address them has been agreed between the parties concerned.

Progress in each of these areas will be reviewed in the context of the overall review of this Sectoral Plan which will take place in 2007.

6.2 Housing

To bring a new focus to addressing the housing needs of people with a disability, a National Housing Strategy for People with Disabilities will be developed as recommended in the NESC "Housing in Ireland" Report in order to support the provision of tailored housing and housing supports to people with disabilities. This would have particular regard to adults with significant disabilities and people who experience mental illness. This will be progressed through the establishment of a National Group under the aegis of the Housing Forum headed by the Department of the Environment, Heritage and Local Government and involving the Department of Health and Children, the Health Service Executive, social partners and other relevant stakeholders, e.g. the national Disability Authority.

As part of this approach, new protocols will be established for inter-agency co-operation for all special housing needs, so that a combined approach to the accommodation, care and support dimensions is taken.

Section 12 of the Disability Act 2005 provides for exchange of information between the HSE and public bodies (including housing authorities) for the purpose of assisting a person with disabilities in applying for personal or individual services provided by the body relevant to his or her needs. It requires that, where a public body has been notified of a possible need (e.g. a housing need in the case of a housing authority), a member of staff of the body shall communicate with the person with a disability for the purpose of facilitating or co-ordinating the provision of any services that it considers he or she is entitled to. A protocol will be developed to deal with liaison between the HSE and housing authorities on this matter. This approach along with the proposed protocols on the more strategic assessment of need should improve the capturing of special housing needs such as those of persons with a disability.

6.2.1 Inter - Agency Protocols

Protocols, to deal with co-operation between the HSE and housing authorities are required to provide a strategic framework for inter-agency co-operation at local level. It is intended that protocols will be agreed as appropriate between the Health Service Executive and Housing Authorities to deal, inter alia, with the following areas:

  • Assessment of housing needs - a protocol, to be developed in the short term, will aim to govern liaison between HSE and local authorities on both strategic assessments of local housing need and assessment of individual accommodation needs of people with disabilities who have been identified by the HSE under the assessment of need process consistent with Section 8 of the Disablity Act, 2005 and made known to the housing authorities under the provisions of Section 12 of the Disability Act, 2005;
  • Strategic Assessment of the nature and extent of local housing needs of people with a disability - a protocol will be developed, in the medium term, aiming to govern liaison between the HSE and local authorities and exchange of information necessary for this purpose. This will input into the development of housing action plans;
  • Support costs for social housing projects provided for people with disabilities - this protocol, to be developed in the short term, would apply to projects provided by housing authorities and the voluntary and co-operative housing sector where there is an ongoing care/support dimension required in addition to accommodation needs.

6.3 Income Support

6.3.1 Allowances Administered by the Health Service Executive

The HSE administers a number of allowances/grants schemes which, between them, account for some €70m of annual health spending on disability. These schemes are not based on statutory entitlements and the majority have not been updated since they were first introduced.

The Domiciliary Care Allowance relates to the extra care and attention which may be required in the case of children with a severe disability. It was introduced at a time when support services from statutory health bodies were at a very early stage of development.

The Blind Welfare Allowance is payable in respect of a particular cohort within the disability sector, dating from a time when it was considered desirable to introduce some scheme of monetary assistance, particularly for ex-servicemen who had been blinded in the course of wartime activities.

The Motorised Transport Grant is paid towards the purchase of a car by a person with a severe disability where such a car is essential for him/her to obtain or retain employment, while the purpose of the Mobility Allowance is to allow people with disabilities who are not car owners to make arrangements for their transport needs.

In line with mainstreaming policy, there is now general agreement that responsibility for various payments to people with disabilities would sit better with the Department of Social and Family Affairs. This approach was reflected in a Government Decision in February 2006 concerning the implementation of the Core Functions of the Health Service Report which provided that income support and maintenance schemes, together with associated resources should transfer from the Dept of Health and Children/HSE to the Dept of Social and Family Affairs. An Inter-Departmental Working Group has been established to implement this decision with reference to the allowances mentioned above. The work of the group will include a rationalisation of allowances and the development of appropriate legislative proposals to reflect the transfer of responsibility.

As stated in the recent Partnership Agreement, in terms of ensuring adequate levels of income for people with disabilities, it is intended to work for the continued enhancement and integration of supports in line with overall social welfare commitments and targets.

6.3.2 Protocol Agreed with the Department of Social & Family Affairs

Ensuring that income supports and associated benefits do not create financial barriers to people with disabilities seeking or accepting employment or improving their employment status is a key objective of the National Disability Strategy. The co-ordination of the removal of such disincentives (often referred to as "the benefits trap") requires cross-departmental action. For example, this will include consideration of the issue of income limits which currently apply for receipt of the medical card and for secondary payments currently administered by the Health Service Executive. Some progress has been made already in this area. With effect from June 2006, a single person in receipt of Disability Allowance or Blind Pension who takes up employment will continue to receive his or her allowance, on a sliding scale, until the earnings from employment reach €390 per week. This measure, which was introduced in the 2006 Budget, is intended to support people with a disability in taking up employment. However, at present, income from paid employment is reckonable for the purposes of assessing a person for a medical card. For a person with a disability, the potential loss of a medical card could act as a significant disincentive to taking up employment.

In recognition of the need to adopt a "whole of Government" approach to the needs of people with disabilities, it has been decided that a person with a disability in receipt of Disability Allowance or Blind Pension who avails of the opportunity to take up employment will be allowed to retain his or her medical card for a maximum of three years from the date on which he or she takes up employment.

As signalled in the new social partnership agreement, Towards 2016, it is intended to review the eligibility criteria for assessment of medical cards in the context of medical, social and economic need. The review will clarify entitlement to a medical card for all, including people with disabilities. The new arrangements above will continue until new eligibility and assessment arrangements are put in place following completion of the review.

As part of the preparation for the publication of this Sectoral Plan, the Department of Health & Children met with the Department of Social and Family Affairs to discuss the issues of mutual concern in relation to service provision for people with disabilities. In order to reflect the commitment to co-operation, a protocol has been agreed with that Department as outlined below. It identifies key objectives in relation to income support measures for people with disabilities and actions which require cross-departmental co-operation. This protocol will be similarly incorporated into the Sectoral Plan of the Department of Social and Family Affairs.

PROTOCOL FOR INTER-DEPARTMENTAL CO-OPERATION

Part 3 of the Disability Act, 2005, provides for the preparation of sectoral plans by six Departments, including the Minister for Social and Family Affairs and the Minister for Health and Children, and for the appropriate co-operation between the Ministers in relation to the development and co-ordination of services for persons with disabilities.

The mission of the Department of Social and Family Affairs is to promote a caring society through ensuring access to income support and related services, enabling active participation, promoting social inclusion and supporting families.

The main functions of the Department which include the provision of services to people with disabilities are:

  • To formulate appropriate social protection policies;
  • To administer and manage the delivery of statutory and non-statutory social and family schemes and services; and
  • To work with other Departments and agencies in the delivery of Government priorities.

The mission of the Department of Health and Children is to help enhance the health and well being of all by

  • Supporting the delivery of high quality, equitable and efficient health and personal social services;
  • Leading change in the health system:
  • Putting health at the centre of public policy; and
  • Promoting a 'whole of Government' approach to health and social gain.

The management and delivery of health and personal social services is the responsibility of the Health Service Executive under the Health Act 2004.

This protocol recognises the commitment of both Departments to work closely together to harmonise their endeavours and to increase the effectiveness of the delivery of services for people with disabilities.

Outlined below are the objectives, actions and timeframes which the two Departments will work together to achieve in the context of progressing the commitments within the Sectoral Plans.

Objectives

Actions

Timeframes

To develop income and related supports for people with disabilities in order to ensure that they have adequate, secure and sustainable income

Implement the Government decision on the transfer of income maintenance functions of the Department of Health and Children/Health Services Executive to the Department of Social and Family Affairs

Commenced May 2006 with establishment of an inter-departmental working group. Initial report to Government by October 2006. Transfer process 2006-09.

Extension of eligibility for payment of full Disability Allowance to all those in residential care

By the end of 2007

To ensure that income supports and associated benefits do not create financial barriers to people with disabilities participating in the labour force or availing of training/ educational opportunities

Co-ordination of the removal of disincentives across schemes

Ongoing

Review of eligibility criteria for assessment of medical cards

To commence 2006

Retention of HSE allowances for persons awaiting of DA earnings disregard

Completed by September 2006

Consideration of issues around the cost of disability will be considered

Following the development of a needs assessment system provided for under Part 2 of the Disability Act, 2005

To ensure that supports to Carers are efficient and effective and are adaptable to their needs in a changing care environment

Implementation of the recommendations of the working group on long-term care

Ongoing

6.4 Employment

As stated above, people with disabilities have traditionally had most of their needs addressed within the ambit of specialist disability services. The Commission on Disability (1996) recommended that “overall government responsibility for vocational training and employment of people with disabilities should be assigned to the Department of Enterprise and Employment”. This was followed by a Government Decision in 1998 which stipulated that vocational training and employment services for people with disabilities, including sheltered and supported employment were to transfer from the Department of Health and Children to the Department of Enterprise, Trade and Employment.

While responsibility for vocational training has transferred, there has been less progress in regard to the issue of employment services. The HSE currently funds a range of both sheltered enterprise and sheltered employment services for people with intellectual disabilities and mental health difficulties. In accordance with the Government Decision on mainstreaming and taking account of the more person-centered approach to service provision under the Disability Act 2005, it is envisaged that there will be a phased transfer of funding and responsibility for appropriate employment services including sheltered and supported employment from the health sector to the Department of Enterprise, Trade and Employment/FAS over the next three to five years.

The mission of the Department of Enterprise, Trade and Employment is to work for Government and the people to increase quality employment and national competitiveness.

The Department of Enterprise, Trade and Employment will continue:

  • to develop the skills of people with disabilities to enable them to access employment and to realise vocational progression
  • to promote awareness among employers of the contribution that people with disabilities can make to their businesses and to materially encourage them to recruit such workers
  • to provide employment supports for people with disabilities and for employers.

The Department of Health and Children will:

  • Continue the work of the National Coordinating Committee and provide representation on the FAS National Disability Advisory Committee

The HSE will:

  • establish a clear framework for the delivery and enhancement of a range of targeted day services, including day care, life skills training and personal development and joint bridging programmes for people with disabilities, in response to individual identified needs and within the context of person centred planning.
  • provide appropriate health supports for people with disabilities, including those in supported employment
  • maximise participation in the High Supports Process.

The two Departments are committed to improving the effectiveness of the delivery of services to people with disabilities in the following areas:

  • to plan and develop a Joint Bridging programme between health-funded rehabilitative training services and vocational training services to ensure progression and vocational advancement for users who have the ability, skills, aptitudes, interest and potential to progress from rehabilitative to vocational training.
  • to establish a Working Group to report to Ministers by the end of 2006 regarding the scope and arrangements for the phased transfer of appropriate employment services from the health sector to the Department of Enterprise, Trade and Employment.

This change programme will form part of the “comprehensive employment strategy for people with disabilities” referred to in the recently concluded Partnership Agreement “Towards 2016”.

The Department of Health and Children and the HSE welcome the proposed establishment by Department of Enterprise, Trade and Employment of a Consultative Forum on Employment and Vocational Training Provision for People with Disabilities and will be pleased to participate fully in the work of the Forum.